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Nutritional Challenges of Dementia . Presented by: Pam Polk, RD, LD Healthcare Account Mgr. Objective. Discuss nutrition interventions to help maintain optimal nutritional status & hydration status at different stages of Dementia. Est. 24 MM people living with some type of dementia

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nutritional challenges of dementia
Nutritional Challenges of Dementia
  • Presented by:
    • Pam Polk, RD, LD

Healthcare Account Mgr.

objective
Objective
  • Discuss nutrition interventions to help maintain optimal nutritional status & hydration status at different stages of Dementia
slide3
Est. 24 MM people living with some type of dementia
  • By 2015 could be epidemic numbers
  • Many types of Dementia – Alzheimer's main type we hear about
most important goal
Most Important Goal:
  • Prevent weight decline
  • Maintain hydration
general symptoms
General Symptoms
  • Loss of interest
  • agitation
  • Withdrawal
  • Changes in eating habits
  • in hygiene / self-care habits
  • Repetition
very important
VERY IMPORTANT!!

May be difficult for them to express pain….

Only indication of PAIN may be that they stop eating

  • Rule out other things that might be causing changes in weight, behavior, etc.
  • Poor dentition
  • Mouth sores
  • Limited use of extremities
  • Diabetes
  • Heart Disease
  • CVA
  • Depression
  • Constipation
  • Agitation
early stages
EARLY STAGES
  • Goal: hydration, nutrition, independence
  • Few interventions
  • Confuse foods with non-foods
  • May have to alter environment
  • Low tolerance for new ideas (menu changes, etc.)
early continued
EARLY CONTINUED
  • SYMPTOMS:
    • food intake
    • cereal consumption
    • sweets
    • Excessive sodas ( in caffeine may have incontinence, agitation)
    • Forget to eat or drink (or forget they already have)
    • May have weight loss or weight gain
early continued9
EARLY CONTINUED
  • RESULTS:
    • Vitamin deficiency

What looks like dementia??

UTI

Low Potassium

Low B12

Low Iron

early stages10
EARLY STAGES
  • INTERVENTIONS:
    • nutritious foods
    • fluids
    • Simple menus
slide11

LUNCH

Dessert:

Yellow Cake with Chocolate Icing

Fresh Fruit

Pudding

Ice Cream (Vanilla, Strawberry, Choc)

Sherbet (Lime, Orange, Rainbow)

Beverages:

Milk (1%,2%, Whole, Skim, Choc)

Juice (Orange, Grape, Cranberry, Apple, Prune)

Iced Tea (Sweet, Unsweet)

Hot Tea

Coffee

Entree:

Roast Beef

Turkey Cacciatore

Chef Salad“

Catch of the Day”

Sides:

Mashed Potatoes with Gravy

Seasoned Rice

Zucchini

Seasoned Sugar Snap Peas

Vegetable Beef Soup w/ Crackers

Dinner Roll

Garlic Bread

Bread (white / wheat)

middle stages
MIDDLE STAGES
  • GOAL:
    • Nutrition
    • Hydration
    • Weight maintenance
general symptoms13
General Symptoms

Forget to eat

Not find way to dining room

Forget table manners

Forget they have already eaten

caloric needs due to walking

Unable to recognize utensils

sugar intake

smell

effective communication

LATER MAY HAVE CHEW / SWALLOW ISSUES

middle stages14
MIDDLE STAGES
  • INTERVENTIONS:
    • Finger foods
    • Season and color on foods
    • Small plates to prevent being overwhelmed
    • Serve one item at a time
    • Don’t over stimulate
finger food examples
Finger Food Examples
  • Cheese Sandwich Bites
  • Vegetable Sticks
  • Baby Carrots
  • Dressing Balls
  • Brussels Sprouts
  • Sliced Apples
  • Sliced Peaches
  • Broccoli
  • Baked Potato Bites w/ Sour Cream for Dipping
  • Sliced Peaches
  • Chicken Salad Sandwich Bites
  • Meatball Bites and Rotini
  • Banana Bites
  • Meats cut into Bite – Sized Pieces
  • Gravy and Sauces on the Side for Dipping
  • French Fries
  • Green Beans
  • Roll / Bread
  • Cake Bites
  • Pineapple Chunks
  • Breaded Squash Bites
  • Rotini Pasta
  • Cookies
finger food examples16
Finger Food Examples
  • Cabbage Wedge
  • Fresh Fruit
  • Cheese Sandwich Bites
  • Vegetable Sticks
  • Baby Carrots
  • Dressing Balls
  • Brussels Sprouts
  • Sliced Apples
  • Hot Cereal in Mug
  • Soup in Mug
  • Buttered Biscuit
  • Corn Fritters
  • Fruited Gelatin Cubes
  • Brownie
  • Sweet Potato Bites
  • Chicken Salad Sandwich Bites
  • Meatball Bites and Rotini
  • Banana Bites
  • Hot Cereal in Mug
  • Soup in Mug
  • Buttered Biscuit
  • Corn Fritters
  • Fruited Gelatin Cubes
  • Brownie
  • Sweet Potato Bites
late stages
LATE STAGES

GOAL:

Maintain weight

Dignity

Quality of life

late stages18
LATE STAGES

Chew / Swallowing Difficulty

May pocket food

Forget to chew or swallow

Refuse food

Not recognize food

Weight loss

know understand the resident
Know / Understand the Resident
  • Resident may not be the best source
  • L/D/A
  • Environment:
    • May have decreased attention span
    • Problems focusing
slide20
Communicate clear, calm, neutral tone
  • Consistency
  • Well-lit area
  • Avoid patterns on table cloths/ china
  • Extra time to eat
  • Have only needed utensils at the table
staff
STAFF
  • Well-trained staff can calm agitated residents and make meals pleasurable
  • Monitor resident self-feeding
  • Verbal & tactile cueing
  • Name, eye contact, compliment
  • Calorie dense finger foods
  • Coach to use utensils
  • Remind to chew / swallow
  • Encourage independence
  • BE POSITIVE ABOUT THE MEAL (even Puree)!!
slide26

Water plays a CRITICAL role in these body functions:

  • Transfer nutrients and oxygen to cells
  • Acts as a solvent for most nutrients
  • Remove waste from cells
  • Lubricant in joints
  • Regulate body temperature
  • Prevent constipation
  • Assist digestion & absorption
  • Maintain blood volume
slide27

Sources

Liquids are most obvious source

Solids do provide some water

reasons elderly have decreased fluid intake
Reasons elderly have decreased fluid intake:

Fear of incontinence

Not like taste of water

Thirst mechanism decreases with age

Chronic illness interfere with normal eat & drink

Alcohol increases fluid requirement

Decreased renal concentrating ability

Do not conserve water well

Handling cups is difficult

slide29
Risk Factors:

Confusion

Fever

Diarrhea

Bed bound

Previous episodes of dehydration / vomiting

Diuretics

Aspiration

High protein diets

slide30
Symptoms:

Fatigue

Thirst

Headache

Dry nasal passages

Dry cracked lips

Overall discomfort

Swollen tongue

Mental confusion

Decreased skin turgor

Constipation

  • UTI
  • - Fever
  • - Decreased appetite
  • - Nausea
  • - Changes in lab values
  • - Decreased BP
  • - Urine concentration